Chapter 27 Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson

Chapter 27 Medical Surgical Nursing 2nd Edition By Osborn Wraa Watson

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Question 1

Type: MCMA

A patient has been prescribed isoniazid (INH) and rifampin for the treatment of tuberculosis. The nurse should instruct the patient to report which physical changes associated with this therapy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fever
2. Yellow tint to the skin
3. Discoloration of tears
4. Visual disturbances
5. Loss of appetite

Correct Answer: 2,4,5

Rationale 1: Fever is not an expected adverse effect of this therapy.

Rationale 2: Jaundice could indicate the patient is developing hepatitis, which is a possible adverse effect of this therapy.

Rationale 3: Discolored tears are an expected effect of rifampin. The nurse should advise the patient that this effect is possible, but reporting it is not necessary.

Rationale 4: Visual disturbance is an adverse effect of isoniazid and should be reported.

Rationale 5: Loss of appetite is an adverse effect of rifampin and should be reported.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 27-2

Question 2

Type: MCSA

A patient diagnosed with tuberculosis is prescribed ethambutol (Myambutol). Which nursing statement is indicated?

1. “Are you allergic to eggs?”
2. “Before starting this medication, you must have a baseline eye examination.”
3. “You will need an influenza vaccine before starting this medication.”
4. “Before you start this medication, we must schedule a baseline ECG (electrocardiogram).”

Correct Answer: 2

Rationale 1: Assessment of an allergy to eggs is not warranted prior to the implementation of this medication.

Rationale 2: A possible toxic but reversible effect of this medication is optic neuritis. Eye exams also may be scheduled during the course of treatment.

Rationale 3: Administration of a flu vaccine is not warranted prior to the implementation of this medication.

Rationale 4: An ECG is not warranted prior to the implementation of this medication.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 27-2

Question 3

Type: MCSA

A patient has been diagnosed with a restrictive lung disease. Which assessment finding would the nurse expect?

1. Cough that the patient describes as occasional for the last 2 weeks
2. Bradycardia
3. Patient report of increased shortness of breath when walking
4. Clear lung sounds

Correct Answer: 3

Rationale 1: The cough associated with restrictive lung disease is chronic and of prolonged duration.

Rationale 2: Tachycardia is the more common cardiac response to restrictive lung disorders.

Rationale 3: Progressive exertional dyspnea is a finding associated with restrictive lung disease.

Rationale 4: Bibasilar inspiratory crackles are a common finding in restrictive lung disorders.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 27-1

Question 4

Type: MCSA

A patient with chronic obstructive pulmonary disease (COPD) tells the nurse that he does not always wear the prescribed oxygen at home because it is cumbersome and he is rarely short of breath. What is the nurse’s best response to this patient?

1. “Wearing the oxygen will help keep your blood oxygen saturation levels up so your heart does not have to work as hard and will not become enlarged.”
2. “You really should wear it at least while sleeping.”
3. “You do seem to be doing fine without it.”
4. “Keep the oxygen at home and if you become short of breath, you know to put it on until you are able to breathe normally again.”

Correct Answer: 1

Rationale 1: The nurse should instruct the patient on the benefit of using long-term oxygen therapy to prevent polycythemia vera, an increase in the hematocrit level above normal as a compensatory mechanism to hypoxia. Cor pulmonale, an enlargement of the right side of the heart, can also develop and can lead to mortality in the patient with COPD.

Rationale 2: The nurse should encourage the patient to wear the oxygen at all times and not just during sleep.

Rationale 3: It may be misleading to state the patient is doing fine without the oxygen.

Rationale 4: The nurse should not instruct the patient to wear the oxygen just when he becomes short of breath but to wear it at all times as prescribed.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 27-3